So . . . what's this here single-payer health care thing all about anyway?

"I�m going to tell you something -- we have fabulous health care in America, just so you know. I think it�s very important -- before people start griping about the health care system here -- and of course there�s always grounds for complaint -- just to compare it with other systems around the world." --George W. Bush, December 17, 2007, eruditely discussing his own single-payer coverage, courtesy of the US taxpayer.

Note: please pardon all the weird characters -- like question marks where there should be quotation marks. I'm a writer; not a coder. However, if you know how to fix this crap, please shoot me an email and tell me how. ALso looking to truncate posts to show the first 500 words, then show a link to the rest at the bottom of the opening section. Again, if you know how to make that work, please tell me how. And now, on with the show...

But first, a moment of silence

A teenaged girl died some time ago because Cigna HealthCare, a for-profit medical insurance provider, did exactly what it's compelled to do by law: it chose to maximize its profits by refusing to pay for a liver transplant for 17-year-old Nataline Sarkisyan, whose doctors warned that she would certainly die without the organ replacement.

And they were correct. She did in fact die, just hours after Cigna relented and agreed to cover the costs of the procedure after all. This, too, was a move intended to maximize profits, since the terrible PR that news of its denial of coverage generated could have affected Cigna's bottom line as well, as could damages awarded as the result of a wrongful death suit. So it wasn't a rekindling of the human spirit on Cigna's part that caused the company to reverse its position; that was the result of a serious internal disaster management campaign, run by corporate lawyers and high-level spinmeisters, designed to reduce the impact on Cigna's image and minimize the company's financial exposure.

By law, the only obligation of a publicly owned, for-profit US corporation is maximizing return for its shareholders. That's it. Nothing about good corporate citizenship, the public good, saving lives or anything else that isn't related to jacking up the price per share and maintaining a reasonable price-earnings (P/E) ratio.

If Cigna had been operating outside the rules, perhaps we could simply discipline that one company, levy stiff fines, jail a couple of high-ranking execs and serve notice to the rest of the industry that such behavior won't be tolerated. But that's not the case. Cigna was following the rules. The problem is that the rules are insane. That's why this profit-driven disaster of a medical system must be replaced.

We need to dump this murderous system entirely. It's too far gone to tinker around the edges. We simply have to get rid of the profit motive as the driving factor in determining who lives and who dies. We need to decouple the idea of health care from the idea of health insurance, since the two have absolutely nothing in common. For example, listen to Cigna president David Cordani defending the decision in an internal memo that was also made available to mass media.

Nataline Sarkisyan's request was evaluated on an expedited basis using "evidence-based guidelines published by independent physician and medical organizations, as well as expert scientific journals," Cordani said. Translation: We made a life or death decision based on a quick scan of "Liver Transplantation for Dummies" and we backed that up with a little reading on WebMD. Oh, and JAMA, too, and Lancet maybe . . . And don't forget Dr. Rudinski's best-seller, "The Home Guide to Major Abdominal Surgery."

Now back to our regularly scheduled programming . . .

The pinko commie plot to ruin the American way of debt and dying

Now that "Sicko" is available on DVD, millions of people will see it for the first time. If the film's run in theaters is any indicator, most of them will be infuriated as Michael Moore exposes a greedy US medical insurance system run amok, drunk on profits, willing to abandon any last traces of human decency to fatten the bottom line and adept at filtering out patients with acute illnesses that might cost the insurers real money.

The solution Moore advocates is a national health care program, funded by a modest and progressive tax, and generically called "single-payer," meaning that the insurance industry's multiple payers are replaced by a single entity, usually a state or the federal government.

This system would provide universal access to health care for all Americans without the need for private, for-profit medical insurance and the huge financial burden that currently imposes in insurance premiums, deductibles, co-pays, pharmaceuticals, non-covered procedures and "negotiated rates" which somehow never seem to cover the entire bill.

And those people are the lucky ones; they have medical insurance of some sort and, therefore, aren't usually sentenced to die (Nataline Sarkisyan excepted) or be forced to use the local ER as their primary care facility. That happy fate falls to an estimated 47 million of their fellow Americans, who have no medical insurance at all and must therefore game the system to survive.

And we're not talking solely about the chronically unemployed (although why employment is a condition for receiving medical care remains unexplained and undiscussed). We're talking about Wal-Mart greeters and checkers, burger flippers, cab drivers, the self-employed, retail clerks, waiters, bartenders, most non-union workers in most trades and an endless list of service economy employees.

These people all have jobs; many have two or three. But they work for employers who can't afford today's obscene medical insurance premiums. Or they work for world-class cheapskates like Wal-Mart, which rakes in many billions each year, whose billionaire Walton family owners occupy a special pedestal among Forbes magazine's list of richest Americans, but who just can't seem to spare a few bucks to help keep their workers healthy and free from medical debt.

The very words "single-payer" give many of our more delicate citizens the vapors and drive many more into an apoplectic rage. These magic words also cause the last of the cold warriors to dissolve into a frothy lather of anti-pinko invective about subverting the invisible hand of the free market.

Considering the massive propaganda campaign waged non-stop by for-profit medicine and seconded by stern warnings of the "evils of socialized medicine" intoned by well-insured right-wing politicians and TV pundit hucksters, those kinds of adverse reactions aren't all that surprising. The buzzwords and visual cues and code phrases are hard-wired by the time kids hit the sixth grade. Go here for a scholarly treatment of the single-payer/for-profit debate.

In the case of the US medical system, we've been taught by our leading opinion-shaping institutions -- public relations, marketing and advertising -- that health care is a privilege to be auctioned off to the highest bidder and not a universal right to be shared by and for the general welfare of society.

Single-payer butts heads with the American archetype

We're so steeped in the rugged individualist, go-it-alone archetype that the idea of making common cause with "those other people" -- working toward a shared objective of improving quality of life for all members of society, not just those who can afford it -- is anathema and, increasingly, un-American. I fully expect some gasbag GOP presidential candidate, before primary season mercifully ends, to come up with something like, "If we go to a non-profit health care model, the terrorists win." Any bets?

class="MsoNormal">In fact, our apathy or antipathy toward those who don't share our looks, background, ideals, language, income, education or culture is driving the US toward an endgame that bears an uncanny resemblance to the Friedman/GOP-style unregulated free market model, with peace for none and antagonism toward all.

We're becoming a society of 300 million disconnected, semi-autonomous city-states, constantly at war with one another for the same dwindling supply of goods and jobs, and services and money, and square feet of pavement. A society too distracted and exhausted by the process of battling each other to notice the class war being waged -- and won -- against us all by the very people who designed and sanctified this system in the first place.

They've divided and conquered very well. No surprise, given the massive resources of the entire insurance industry, along with an approving pat-on-the-back from our "representatives" in Washington; it would be odd if they hadn't done a good job of keeping us at each others' throats and away from theirs.

The insurer as friend and savior

Distraction also helps produce the suspension of critical thinking required to believe in the most illogical premise of all: that America has the best medical care system in the world and has achieved that lofty position because the most voracious, profit-hungry, inhuman corporate institutions routinely ignore their very reason for existence, as well as a file cabinet full of SEC regulations and case law precedents that demand a publicly held corporation pursue profitability with single-minded, sociopathic disregard for basic human values. This is nothing less than a case study in the impossible, but it's the core tenet of the great American health care fairy tale nonetheless.

So are these corporations portrayed in media and pop culture as the enemy, as one would expect? Of course not; they're the solution. The US, unique in the world in its child-like belief good citizenship from corporations, expects these rapacious profit machines to completely abandon their chartered mandates requiring them to churn out ever more money for their stake-holders and, instead, act in the best interests of their customers.

Never mind that those two objectives are locked in inexorable conflict. Never mind that medical insurance is a zero-sum game and, when the insurer pays a claim, that's money grudgingly subtracted from the bottom line. Never mind that the insurance industry employs an army of obstructionists -- known ridiculously as claims adjusters -- whose main job it is to find some quasi-legal way to avoid paying out any money at all. Never mind the inevitable outcome of those conflicts: that the US isn't even in the top 30 according to the landmark 2000 World Health Organization study. Nope, never mind all that. The industry is our friend and savior, and where would we be without it? Other than healthier and happier, with more disposable income, that is.

As one California psychologist who serves on several managed care rate negotiating teams in the Santa Cruz area told me a while ago, �They have become adept at providing the illusion of health care, while avoiding the messy and expensive reality of having to actually deliver it -- to the extent legally possible. And you�d be amazed at what�s legally possible. Most of the time you can�t even sue them so, at some point, the consumer literally has no recourse but to beg for his or her life. Increasingly, those pleas fall on deaf ears as the race to maximize profits obliterates what�s left of basic human kindness.�

So much for the bad news. We now need to examine the nature of single-payer, universal-access health care: what it is, what it isn't, how it compares and contrasts with the US for-profit model.

So what exactly is single-payer and why is it better than what we have now?

Well, surprise, surprise, it's not socialized medicine. The federal government won't set up shop in every doctor's office and medical facility. Unlike the current system, in which privatized pests occupy a permanent position overlooking every doc's shoulder, governmental bureaucrats won't be making harassing calls to doctors offices every five minutes to second-guess whether a patient actually needs that procedure, or that test, or that prescription.

Let's say your doc has his own small family practice, which he runs as an LLC. He probably accepts payment from a couple dozen different insurance carriers. Does that mean he works for, say, Blue Cross or Cigna or Aetna? Of course not.

Under single-payer, he would no more work for the government than he now works for an insurance company. He gets paid by the feds, but runs his own business exactly as he has for many years.

So docs and hospitals continue to operate as they always have, although for-profit facilities must convert to non-profits. The truly revolutionary change is that now the feds foot the bill via a progressive tax that hits the rich hardest and the poor not at all.

In fact, if a patient just looks at the outward signs, things are very much as they've always been. You see the same doctors and support staff. You have blood drawn at the same labs. If you're seriously injured or suddenly become ill, you end up at the same ER. You see the same specialists. If surgery is required, the same group of medical professionals handles the entire process -- from pre-op to rehab. You find that service is about as fast, or as slow, as ever. And if you want a tummy tuck or nose job, you're still going to have to pay for it out of your own pocket.

The payer changes -- from any of hundreds of private insurance companies to a single entity -- but the process of providing and receiving medical care remains the same. Actually, it improves because single-payer eliminates the armies of bureaucrats the insurance industry employs in an effort to squeeze the last mil out of every penny by denying coverage or illegally reducing benefits.

Single-payer: the basics

The following is the nature of any single-payer health care system. Simple, direct, universal, free. And having tried the alternative and found it wanting in that it's currently killing around 18,000 people a year because making gobs of money is incompatible with covering subscribers' medical costs, it seems about time to admit our errors, dismantle the current tragicomedy and move all the way into the 21st Century.

Single-payer means:

• One nation, one payer
  
  
• Everybody in, nobody out
  
  
• No exclusions for pre-existing conditions
  
  
• No doctor bills
  
  
• No hospital bills
  
  
• No deductibles
  
  
• No co-pays
  
  
• No in network
  
  
• No out of network
  
  
• No corporate profits
  
  
• No more medical bankruptcies

How to get there from here

The relationship of health care to health insurance is manufactured out of thin air by the US obsession with applying market-based, privatized solutions to nationalized, systemic problems. Therefore, it seems that to get to single-payer, we first need to abandon the propaganda and separate the idea of health care from the idea of health insurance.

Health care is what happens when patients and health care professionals interact to successfully diagnose and treat a medical condition or injury.

Health insurance is the protection money you have to pay the middleman to enable this transaction and keep you out of bankruptcy court.

Why would anyone want to give a single penny to some parasite intermediary that skims billions while doing absolutely nothing to provide health care?

Unfortunately, it takes a lot more than pennies to keep the beast fed. While Medicare, our unofficial single-payer system, runs at an annual overhead of about 3 percent, for-profit insurers typically squander between 25 and 40 percent of an estimated $2.2 TRILLION annual market. And that 25 to 40 percent -- which translates into between $550 billion and $880 billion each year -- does absolutely nothing to enable these companies to perform their alleged jobs, which is supposed to be covering medical expenses for their ratepayers.

The unbearable lightness of Democratic politicians

Equally unfortunate is the unwillingness of our elected representatives to even consider single-payer among the options for US health care reform. Among the Democratic presidential candidates, only Dennis Kucinich has advocated single-payer from the start. The rest are all talking about something called "expanded coverage," which is just code for "let's invite the single most destructive element in the old system to play a key role in the new one."

That's a bit like expecting a shark to develop qualms of conscience, renounce killing and turn vegan, despite millions of years of evolution that dictate its natural role as a rapacious, heartless, omnivorous predator. Kind of like an average American for-profit corporation.

Any new system that subordinates health care to the for-profit model carries the seeds of its own destruction. If insanity is doing the same thing repeatedly and expecting different outcomes, then allowing these soulless gatekeepers to continue preying on the people of this country is truly insane. Such a system is virtually guaranteed to evolve into a new version of the same old deadly scam once the insurers stop glad-handing and get down to the serious business of making money. They may play nice at first, promising to mend their rapacious ways and act like humanitarians, but once they're inside the tent, they'll revert to form as certainly as that shark will continue to eat seals.

But that hasn't kept our alleged representatives in Congress and on the campaign trail -- Kucinich the lone exception -- from avoiding any mention whatsoever of the single-payer option. In 2003, Rep. John Conyers of Michigan introduced H. R. 676, dubbed the United States National Health Insurance Act, in an effort to remove private insurers from the US health care maze and install a national single-payer system in their place. The new system is essentially a well-funded version of Medicare, minus the age restriction.

It languished in committee for two years; Conyers then re-introduced H. R. 676 in 2005 and, according to information gleaned from Thomas.loc.gov, it has resumed its slow fall to the bottom of the House agenda. Like impeachment, single-payer remains "off the table," despite the poll numbers that say more than 70 percent of Americans want an end to for-profit medicine and want to replace it with single-payer.

And why is it off the table? For one outstanding example, let's take a look at Hillary Clinton's campaign contributors. The probable Democratic nominee and odds-on favorite to become the next president is an insurance industry money magnet. According to campaign finance figures submitted to the Federal Elections Commission and reported by Opensecrets.org, through the first nine months of 2007 she leads all presidential candidates, Democrats and Republicans, in money accepted from the insurance industry ($2.675M). She also leads the pack in money accepted from hospitals and nursing homes ($375K); from HMOs ($247K); from pharmaceutical companies ($274K); and from medical industry lobbyists ($570K).

As Bob Dole said way back in 1983, before he became the Senate's leading recipient of special interest money, "When these political action committees give money, they expect something in return other than good government." So that just about takes care of any possibility of true health care reform in a Clinton presidency, and virtually guarantees that any Clinton-sponsored health care "reform" plan will bend over backwards to accommodate the needs of the for-profit medical insurance industry.

What about quality of care?

Corporate mass media is ever busy safeguarding the interests of their masters and advertisers, so it's hardly surprising that there's serious opposition to single-payer spewing forth from the television sets and radios of America. People who watch network and cable TV, and actually believe they're well informed, internalize and then repeat industry claims that a single-payer system would lower quality of care, create shortages of medical staff and facilities and result in long waiting lists for even the most mundane procedures. Worst of all, it would be run by demon spawn employed by the federal government.

But, as usual, corporate mass media is lying through its bleached teeth. If that vision of health care hell were true, all other Western democracies would exhibit shorter average life spans, higher rates of cancer and heart disease, higher infant mortality rates, lower birth weights, fewer average healthy years, failing mental health programs and far more serious epidemiological incidents than does the US. Since the opposite is true in all cases, it seems fair to conclude that single-payer, universal-access works, this cobbled together disaster we call a health care system is not getting the job done and that we're being ill served by US media yet again. (Go here for 2004 data on how US per capita medical spending and health care outcomes rank against three of the major single-payer countries.)

The big con: we've already got national health care but the peasants don't get to use it

Perhaps the most galling stat of all: A Harvard Medical School study showed that, back in 1999, the US taxpayer shouldered the burden for just under 60 percent of all medical costs nationwide by being forced to fund health care for federal, state and local government employees. That included programs such as the federal employees health plan and those for state and local employees as well (through state, local and property taxes); the Cadillac coverage our fine representatives and Senators enjoy (which they say we can't have); the costs of covering ER expenses for those without insurance; the costs of running the Medicare program; and the state and local costs of various Medicaid programs.

That 60 percent represented $2,604 per capita at the time, which means government spending per-person on health care in the US was higher than total per capita health care expenditures in any other country in the world -- including those with single-payer, universal-access national health care systems. So we're paying for national health care; we're just not getting it.

This must end; single-payer is the answer, a well-funded Medicare system is the model, greed is the obstacle. Eliminate profits as a factor in life and death decisions, run the entire system based on serving human needs rather than those of shareholders and CEOs, and the profiteers will go elsewhere for their money.

# # #

This article first appeared in Online Journal on January 4, 2008

Setting the record straight: observations on universal health care from actual Canadians

“There are only two ways to allocate any good or service: through prices, as is done in a market economy, or lines dictated by government, as in Canada's system. The socialist claim is that a single-payer system is more equal than one based on prices, but … Canadian health care is equal only in its shared scarcity.” – Wall Street Journal editorial, June 13, 2005.


Thus spoke the leading apologist for US-style vampire capitalism. And that’s a microcosm of what most Americans hear about the Canadian health care system. It’s inefficient, slow, technologically backward, understaffed and, of course, socialist – proving that the ideological demons that provided the rationale for the Cold War can be re-purposed to inspire fear and distrust of virtually anything the American plutocracy deems threatening to its continued economic dominance and massive revenue stream.

The latest smear campaign, engendered by "Sicko," Michael Moore's box office hit documentary/expose on the US health care system, has been hilarious for many Canadians, although some express frustration at watching their successful single-payer, universal-access health care system get trashed in US mass media by dozens of well-paid propagandists or the idiots who believe them, and whose claims of Canadian inadequacy go largely unchallenged.


Lucky Americans: CMcL's saga
About a month ago, I got the following email from CMcL, who lives in Florida, detailing experiences in getting a simple series of blood tests – and getting the insurance company to pay for them.

“I am in the middle of dealing with three medical problems. In order to get some simple blood tests performed this week, I had to do the following:

1. Phone call to primary insurer to ensure coverage
2. Phone call to secondary out-of-state contractor to find approved lab
3. Phone call to doc's office to get procedure code – not known
4. Phone call to first (erroneously chosen) lab to get procedure codes
5. Phone call to secondary insurer to give procedure codes. Lab is not approved even though the hospital it is attached to is approved
6. Phone call to approved labs to find out whether I need new form – no answer at either facility
7. Series of six runaround voice mail messages at lab 1 – after reaching correct person, I get cut off
8. Series of four runaround voice messages at lab 2 – asked to be called back and never was
9. Direct call to lab 2 to confirm procedure code – must have new form from doc
10. Phone call to doc to get new forms – two voice mail messages
11. Phone call to lab 1 – no new form required

“All of this required two hours of my time. For one blood test. In all I was transferred or left a voice message or had to listen to menu options a total of 22 times. For one blood test.”

All this abuse is expensive; to keep CMcL and spouse insured, it costs them more than $11,000 annually in premiums, deductibles, co-pays and the usual arbitrary "gotchas" the industry loves to spring on us. That sum doesn't include one-time costs such as the $3000 out of pocket expenses incurred earlier this year for "routine tests." And then there are pharmaceuticals; if your doc prescribes non-generics, you're probably going to be spending $40 to $150 for a month's supply. Sometimes a lot more.

Well thank the deities CMcL isn't in Canada, where we're told the experience at the hands of the soulless state-run health care system would make the US for-profit model look like nirvana. Or possibly not…


Here’s a weird idea: let’s ask some Canadians
Given all the horror stories we in the US hear about waiting times, lines, inefficiency, understaffing and such, I decided to ask Canadians how similar blood work would be handled there, what it would cost, what the waits would be like, and so on. So I asked Canadian participants on a couple of popular political/social-issues bulletin boards to react to CMcL’s story.

Just regular people from nearly every province – no government officials, no spin, no propaganda, no weird agendas. As it turned out, their sole common denominator was the desire to set the record straight and, in the process, inform their southern neighbors that we’re being lied to every single day by paid apologists and cheer leaders for the status quo.

I got 24 separate responses. Unfortunately, all of them won’t fit here, so I included only the 12 replies that focused narrowly on blood tests in particular, rather than using other medical procedures as evidence to refute the argument for the US market-based model.

(And there were quite a few of the latter; one from Angiej, a Canadian temporarily sentenced to living in Houston who maintains that her father in Quebec would have died under the US system because he would have been denied coverage and couldn't have afforded the procedure out-of-pocket. It's a constant source of worldwide amazement that lack of medical insurance in the richest country in human history can be a capital crime.)

I don’t pretend these stories are representative of the experiences of all Canadians in similar circumstances. Nor do I pretend this is a random sample large enough to draw statistically valid conclusions. It pays no attention to demographics, so responses can't be weighted accordingly. I didn’t ask a series of scripted questions. In short, the whole thing is just anecdotal. (For serious statistical analysis, go here to pore over the numbers compiled by the World Health Organization comparing the overall effectiveness of 191 countries' health care systems. More on that study below.)

All respondents preferred confidentiality, so screen names are the only identifiers used here. Each respondent is also identified by gender and province. Date and time stamps from emails are included. All statements are verbatim, except where edited for length or clarity (in italics). So, anecdotal or not, I think you’ll see a common theme emerge fairly quickly…


In their own words
We don't often hear the unvarnished truth in a country that has perfected the art of spin. But when a dozen people who don't know each other all say pretty much the same thing on the same subject, the circumstantial evidence mounts up quickly. I suppose they could all be in on some vast socialist conspiracy to subvert capitalism by ruining the best health care system in the world – as the US mess is routinely rated by our chest-thumping mass media shills. But probably not… Read on and decide for yourself.


daleo – male, Alberta
Thu Jul-12-07 01:34 PM

I haven't had a blood test for a long time, but my experience has been:

Go to doctor.
Doctor gives you form.
Go to clinic, get blood test.
No bills.


Spazito – female, Alberta
Wed Jul-11-07 10:53 AM

At my doctor's office, after an examination, etc., my doctor would fill in a form detailing the tests to be done and give me a copy to give the lab technician. In the small city I lived in, prior to moving to a larger center last year, I would have to go from my doctor's office up to the hospital where the lab is located, give the form to the clerk manning the desk at the lab and, either wait while the lab technician finished up prior work or go right in and have the blood work done.

After that is complete, I go home and await a call from my doctor's office, usually within the week, telling me the results.

There are no phone calls needed to okay the tests or anything else. There are no payments asked for or made.


SidDithers – male, Ontario
Wed Jul-11-07 11:01 AM

If your family doc wants to test your blood, they will write out a testing requisition form, indicating the type of testing to be done. The patient then takes that requisition form to either their local hospital, or one of a number of private labs to have the sample taken.

We're fortunate in that there is a lab that operates out of the waiting room at our doctor's office. My daughter needed a blood test not too long ago, and it was very easy. At the appointment with the family doc, we were given the blood test requisition, and then we walked across the waiting room to the lab office, waited about 10 minutes for her turn, and then had vials of blood drawn from her arm. No phone calls to insurers, no hassles and no cost to us.


Lautremont – male, Manitoba
Thu Jul-12-07 10:36 AM

I … decided to get a check-up finally after several years and much prodding from my wife. So I had to get a gamut of blood tests, and did so this past Monday. I walked down a couple of blocks to a doctor, having made no appointment. I showed them my provincial health card. They copied down the number, took my blood, and away I went.

I'd brought along a book to read, because after all, wait times in Canada are horrendous, right? I mean, that's what the right wing would have us believe. I didn't have time to read more than a paragraph before I was called in, and I was in and out of the place within 15 minutes. Free and easy like it ought to be. Yes, I know I pay for it with my taxes, but nothing will make you happier about paying taxes (and not nearly such onerous ones as you might think) than medical care that doesn't bust your bank account.


ducati588 – male, Ontario
Sun Jul-22-07 12:43 AM

In Canada the doctor completes a card (5X8) for all of the required blood tests. You take this card to a blood/X-ray clinic, which is usually in the same facility, and the clinic staff draw blood as required. The results are sent to the doctor within a few days or quicker if necessary.

Virtually no wait in the clinic, and the tests are covered under the government plan. The tests are free.


Glarius – female, Ontario
Thu Jul-12-07 10:46 AM

This is very timely... I just went in this morning for blood tests....

The procedure here is this: My doctor, (who we choose ourselves and not the government, despite what right-wingers in the U.S.A. claim) on my visit yesterday gave me a requisition for blood tests which I took into the local lab this morning. The tests were performed promptly (I waited about 20 minutes) there were a few people ahead of me. That was it. No appointment necessary for the lab and NO COST. This is about the 8th time I've had these tests and it's always the same. The case you describe here (CMcL's experience) is absolutely ridiculous. No patient should have to go through that kind of (nonsense).

Somehow or other it seems to me that the right wing conservatives in your country have convinced your citizens that Universal Health Care is akin to that devil...communism… I keep hearing them say that our government runs health care.... choosing our doctors and deciding on treatment, etc. Nothing could be farther from the truth. Our doctors and hospitals make ALL the decisions and send the bills to the government. The government PAYS and that's it.

GET UNIVERSAL HEALTH CARE AMERICA! YOU GOOD PEOPLE DESERVE WHAT THE REST OF THE CIVILIZED WORLD HAS!!!!!!!


Hand – male, Nova Scotia
Thu Jul-12-07 11:00 AM

I get blood work twice a year. Here's how it goes.

1. My doctor fills out a form specifying the tests she wants done.

2. I take the form to the hospital where blood work is done.

3. I take a number deli-style, wait until it's called, hand in the form and show them my provincial health card.

4. I sit back down and wait until my name is called.

5. I go in and get my blood samples drawn.

6. I leave. I don't stop at the cashier because there's no cashier.

7. The lab faxes the results to my doctor. I make an appointment to review them.

The whole process takes maybe an hour, maybe less, maybe more. Depends on how busy they are. Everyone does it this way. Nobody jumps the line, and as far as I know, nobody is denied service. If your health card is expired, they tell you to get a new one (free), but you still get the tests.

End of story. It's based on the assumption that my doctor knows what tests I need and that no one is silly enough to ask for unnecessary blood work. What a concept.

There are no fees for these tests – the service is paid for via tax revenues.


gula – female, Quebec
Wed Jul-18-07 08:56 PM

Pretty much the same (as Hand) here in Québec, except that I go to a local community clinic (CLSC) for the blood samples as it is much faster than the hospital. They, the CLSC then send the samples to the hospital which then sends the results to my doctor and so on. And of course, there is no cost involved.


ironflange – male, Alberta
Tue Jul-17-07 10:58 PM

I get mine done four times a year. Other than that trifling difference, my experiences are identical to yours (referring to Hand, above). The only variation is (4); I've learned the best times to go and don't even have to sit down the odd time. I also have one particular test that has a standing order on it, I can go in anytime and get it with no form or anything. Oh yeah, I've forgotten my card at home a couple of times, so it's a waste of twenty minutes when I have to retrieve it.


Bragi – male, Ontario
Fri Jul-13-07 07:43 AM

I just had my annual check up and my doctor ordered the usual tests (actually, about a dozen or so specific tests were checked off on the list.) The process went exactly as others here have described. It took about 45 minutes in total at a walk-in, first-come-first-served lab.

One thing I did have to pay for, though, is the (quite unreliable) blood test for prostate cancer, which for some bizarre reason is not covered by the Ontario health plan. I think paid $25 for that test.


MrPrax – male, British Columbia
Fri Jul-13-07 08:25 AM

My mom had a blood test last week – she went to her GP for her check-up and he sent her for the usual blood test at a lab she likes to go to. No phoning involved, other than maybe phoning the doctor's office for the test results.

I think the only time anyone has to call their provincial Medicare office is to inform them of a change of address or to get their premiums (in BC) adjusted because their income changed drastically and have to apply for a subsidized rate.


GirlinContempt – female, Manitoba
Tue Jul-31-07 06:51 AM

A couple of weeks ago, I called my doctor. I got in to see her within a few days. We talked about my concerns. She wrote me a little slip for blood work. I went down three floors in the clinic, sat down, and 15 minutes later had my blood taken. One week later, my doctor had the results. No money changed hands.


Stats back up the stories
That's a dozen stories from the socialist hellhole to the north, where blood work doesn't seem to exact quite the mental and financial toll it does in the lower 48. But these tales don't exist in a vacuum; they're supported by mountains of demographic and epidemiological evidence that sits in a gigantic World Health Organization database. When the WHO did its groundbreaking 2000 study, the US ranked 37th overall in a compilation of key indices that include average life span, average disease-free life span, average birth weight, infant mortality rate, access to necessary health care services, cost of those services and so forth. Thirty-seventh.

Which puts us among such famous mainstays of medical superiority as Slovenia (#38), a small part of the former Yugoslavia, and Domenica (#35), a Caribbean island nation of about 70,000 people comprising 289.5 square miles. And I think it's safe to speculate that the US has fallen further in those rankings since 2000 because of growing inequity of access and steeply rising per capita costs.

Canada was ranked 30th at the time, but there are interim studies based on WHO methodology that suggest it’s climbing into the top 10. And who was number one? Think “freedom fries” and “freedom toast.”


A word on the democratization of health care
Here's a picture you'll never see in America: a member of Congress waiting in line with the commoners for his turn at the doctor's office. Here it's generally understood that the rich, the powerful and the well-connected have access to better quality health care than what's available to the serfs, and that's accepted by many as just another perk to which America's modern feudal lords are entitled.

Canadians see things a little differently. Let's let Hand of Nova Scotia describe his experiences under a single-tier, equal-access health care system:

"One time I needed a chest x-ray, which is done by the same procedures that I and others have described – get the form, go to the hospital, hand it in, show your card and so forth.

"Since this is a public first-come-first-serve service, there's often a bit of a lineup, which there was this day (took maybe half an hour from the time I walked in the door). Anyway, while I was waiting in line, I noticed my federal MP (member of the House of Commons, equivalent to a US congressman) also waiting in line in his suit next to the usual lineup of people in jeans and t-shirts or whatever. He didn't jump the line, didn't think of pulling rank on anyone and was content to hang out until his name was called like everyone else.

"I talked to him on the way out since I had voted for him and liked what he said in Commons – he was just there to have an old basketball injury checked on. That's pretty much the way it works in a near single-tier system – to the greatest extent possible, everybody's equal and gets the same level of service.

"That's perhaps the greatest benefit, in my opinion, of a single-payer universal health care system – it's as near to fully democratic as it can be (given that folks with money and/or education generally tend to be able to take better care of themselves). In that way, it helps bind together all strata of society in very real and very important ways. I think people are aware of this and do not begrudge the taxes they pay for the health system, even though the benefits may go more to others than themselves."

Amen.

# # #

A version of this article first appeared in Online Journal August 13, 2007. Go here and here to read my other articles on US health care in the Journal, or just scroll down a bit and read them here.

Health care wars and the lies the for-profit racketeers tell us

Health care is either a right or a privilege: Ultimately, that’s going to be the central question regarding any efforts at health care reform

As Michael Moore’s “Sicko” continues to draw huge crowds and spawn spontaneous health care reform advocacy groups all across the country, the health care industry is planning to hit back hard.

They’ll attack Moore’s credibility, discredit the movie’s core thesis, hammer on the horrors of government control, provide a list of uplifting bullet points detailing for-profit medicine’s contributions to the good of society, conduct endless push polls, create case studies detailing the horrors of other countries’ health care systems, and build a phony but cogent case for continuing the American way of medicine, along with its disgracefully inequitable delivery system.

For-profit medicine – insurance, medical facilities, specialized equipment manufacturers and the like – was a $1.3 TRILLION business as far back as 2000, and it’s safe to say that figure has only increased in the seven intervening years. The companies who have a stake in maintaining that massive revenue stream will do whatever it takes to convince Americans that they would be crazy to modify or dismantle “the best health care system in the world.” As always, PR and advertising will be the preferred weapons of mass disinformation.

Back in the early ‘90s, the “we’re number one” myth’s public faces were a folksy old couple named Harry and Louise, who polluted TV advertising every evening for months reciting industry propaganda and spreading fear of “radical” change that could place our very lives in jeopardy. All this as the ill-fated Clinton health care plan gradually sank beneath the combined weight of its own complexity and the groundswell of public opinion, taught to them by Harry and Louise, against reforming such a perfect system.

This time though, things are a bit different. Anger is everywhere and sharply focused on the source of the problem. Nearly everyone’s had their own personal HMO moment by now, and it’s likely going to take more than the estimated $100 million Harry and Louise campaign to sway public opinion industry’s way. But never underestimate the vast amounts of money the health care racket is willing to spend to keep its front-row seat on the gravy train. They would have spent 10, 20, 30 times the $100 million Harry and Louise cost and still considered it a bargain, given that they retained their ability to bilk consumers out of trillions for another decade and a half. And that kind of money buys some very clever, skillful media strategists and professional opinion manipulators.

Observers of the fine art of manufacturing consent are eagerly waiting to see how the health care industry slithers its way out of this latest assault on its revenue stream. One thing is certain, as the mass media sages like to say: If things get serious enough that Congress actually moves Dennis Kucinich’s HR 676 single-payer, universal-access plan out of committee and onto the floor for a vote, all of us will be the targets and/or victims of the most egregious assault on critical thinking and common sense since the Supreme Court ordered the Florida recount stopped because the results might be prejudicial to Bush’s contention that he had won the state’s electoral votes. And that’s a tough one to beat.

Here are some of the industry's most treasured talking points to scare us into compliance and empty our pockets in service to the god of market-based medicine.


The “S” word
Might as well get it out in the open, because as soon as somebody raises the topic of a taxpayer-funded universal-access health care system for the U.S., the chorus starts bleating “socialized medicine; socialized medicine” like a combination of Chicken Little and the last Cold Warrior, until everybody starts looking under the bed for Commies and subversives.

Fact is, we’ve already got socialized medicine. It’s called Medicare, and it’s absolutely astounding how the subversive evils of socialized medicine for people aged 64 years, 364 days, 23 hours, 59 minutes and 59 seconds are magically transformed into an untouchable entitlement program when the clock ticks one more time.

It’s both comic and tragic to watch our elected representatives fall all over themselves in an effort to defend Medicare while denying its very nature. Comic because only a clown would try so hard to avoid the taint of socialized anything while advocating tirelessly for that very thing. And tragic because the rest of the world doesn’t have to do the free market orthodoxy dance, and gets better and far more affordable health care as a result. We can only look beyond our borders with appreciation and envy as other populations get healthier and ours gets more sickly and desperate by the year.

And here's the crowning insult: The US taxpayer already foots the bill for the bulk of all health care expenditures in this country. A seminal Harvard Medical School study shows that, in 1999, the US taxpayer shouldered the burden for just under 60 percent of all health care costs nationwide. That percentage represented $2,604 per capita at the time, which means government spending on health care in the US was higher than total per capita health care expenditures in any other country -- including those with single-payer, universal-access national health care systems. So we're paying for national health care; we're just not getting it.


More of the usual scare tactics
In late 1993, during the alleged U.S. health care debate, a conservative academic and columnist named Thomas V. DiBacco wrote an article that was picked up by a number of daily newspapers and whose headline read, “Health Reform Could Kill Individualism.” This is in sharp contrast, one supposes, to the current system, which only kills actual people while leaving prevailing free market ideological mythology in place.

But this is the kind of inane argument advanced by privatized health care apologists, as if anyone in his or her right mind gives a tinkers damn about the merits of individualism, American-style, while they’re busy dying on a feces-stained, urine-soaked mattress because they exceeded their lifetime benefits cap and couldn’t afford a hospital bed where they might get treatment, or even a hospice where they might at least die with dignity.

Other phantom phobias and industry favorites include:

• Single-payer will force us to ration health care. Nonsense. Health care is already rationed in this country. Or more accurately, it’s auctioned off to the highest bidder. To the shock of no one, study after study shows that the rich tend to recover from illness far faster and far more completely than the middle class, who in turn are doing way better than the poor. A single-payer plan erases those class distinctions, which may well offend the 4 or 5 percent of the population able to pay out-of-pocket for premium medical care, but will put the rest of us on an equal footing.

Poverty as health risk is borne out by a late-‘90s Tufts University study, which concludes that poverty is the single most dangerous risk factor in America – ahead of genetic predisposition, bad habits, dangerous jobs, extreme sports and poor diet combined.

Which leads us to the inevitable: According to a study released in May 2002 by the Minnesota-based research firm Institute of Medicine, approximately 18,000 Americans die each year because they lack the basic medical coverage necessary to get proper health care. Only in America is lack of private health insurance a capital crime.

• Single-payer will cost too much and raise taxes. Nonsense. The current debacle costs each American more than anyone else, anywhere else in the industrialized world. And payment doesn’t end at the pocketbook; there are some things you simply can’t put a price tag on, like recovering from an illness because you had the right care from the right people at the right time. Managed care, by making sure that none of the above happens without throwing a huge bureaucratic hissy fit, is simply a cruel hoax. After all, if they were so effective at controlling costs, health insurance premiums wouldn’t be rising by double-digit percentages each year.

• Single-payer will kill choice of physicians. Nonsense. Managed care killed your freedom to choose a long time ago. If your doc is in the plan, great. If not, you’re paying a fair percentage of your own medical bills along with your bloated premiums. Single-payer, on the other hand, doesn’t place any restrictions on who you see, despite industry propaganda to the contrary. And logically, if all docs are operating under the same rules and are paid by the same entity, why should there be any questions about freedom of choice? The argument makes no sense.

• Single-payer will create an army of government bureaucrats who will have control over our health care needs. Nonsense. There’s already an army of bureaucrats in charge of our health care. The difference is, private health care industry bureaucrats advance up the corporate food chain largely on the basis of how well they control costs – which is code for how often they’re able to deny coverage without incurring lawsuits. Public bureaucrats, such as Medicare administrators, are also graded on how well they measure up to their job descriptions, although those descriptions rarely include how effective they are at killing off their clientele.

• Single-payer will turn over our health care to the people who run the post office. Nonsense. For all their well-documented inefficiency, the fact is the Feds do many things pretty well – one of which is the Medicare system, which only takes about two or three cents on the dollar to administer, as opposed to the 25 to 40 percent overhead we pay the industry parasites so they can deny us coverage.

Moreover, many things are just too important to be subjected to the bottom-line mentality. Police and fire departments are perfect examples. Both are single-payer, universal-access services provided to the public through a modest tax on all so that individuals don't have to pay for private security or face bankruptcy because of a giant bill for privatized fire-fighting services if their house goes up in smoke.

And really, why would anyone want the air traffic control system privatized? There you are suspended seven miles in the air when the captain comes on the intercom and tells you that Glutco Air Traffic Solutions, Inc. has just laid off 40 percent of its workforce, including most of the people who staffed the control tower at the airport you're heading to.


Industry happy talk and the leaked BC/BS memo
To balance the fear mongering, there will also be continual recitation of happy talk platitudes about how the health care industry is constantly striving to improve service, expand covered procedures, control costs and otherwise incrementally improve the Best Health Care System In The World.

Here are a few “positive spin” talking points excerpted from a leaked Blue Cross/Blue Shield memo written by a communications VP named Barclay Fitzpatrick regarding the anticipated “Sicko” backlash.

• The Blue Cross and Blue Shield Association (BCBSA) and the 39 Blue Cross and Blue Shield companies are committed to improving the U.S. healthcare system for our nearly 100 million members through continuous innovation that reflects the ever-changing healthcare landscape and the needs of the consumer.

• The Blues recognize the need for improvement of both the coverage and delivery of healthcare. But the divisive tone set forth by Michael Moore and his movie "Sicko" is not helpful. Positive change to our healthcare system can be best achieved through shared responsibility, not recrimination. To ensure Americans have access to the best healthcare that is both timely, efficient, and of high quality, requires the collective contribution of all stakeholders -- consumers, providers, employers and the government.

• The Blues participation in the Health Coverage Coalition for the Uninsured is a primary example of how the broader healthcare community is working together to reduce the number of uninsured in the United States.

• The Blues are working on myriad initiatives that ensure Americans have access to quality and affordable healthcare. Each day, Blue Plans across the country are bringing healthcare value to their members in a number of ways such as new advances in health information technology and greater access to cost and quality information.

The Blues, indeed. You can read the entire memo here, which includes the priceless, oft-quoted line “You would have to be dead to be unaffected by Moore’s movie,” and links to a letter from Moore in which he challenges Fitzgerald to a public debate – which will happen about the time my mortgage is paid off.


Beyond the PR wars
After the character assassinations and scare tactics and ads extolling the overarching wonderfulness of the for-profit system, we’ll eventually be presented with a clear choice: Continue to squander huge sums of money on a scam that is systemically incapable of providing decent health care for all. Or follow the lead of every single other industrialized country – and quite a few who aren’t even close to industrialization – and create a fair, universal-access, single-payer system that doesn’t limit its services to those with the fattest wallets.

Most of the rest of the world has decided in favor of the latter. Thus far, the US has taken the former position. It’s up to us, the tens of millions of individuals most affected by this hideous, malevolent, soulless system, to force our representatives to obey their constituents because, other than a few gutsy people like Dennis Kucinich, Congress certainly isn’t going to do this on its own. After all, when has altruism ever been a property of governments, particularly when so many of our alleged representatives are so well paid by the health care racketeers to look the other way.

The for-profit medical system, along with its accomplices and employees in Congress and the executive branch, has managed to con Americans into believing and even parroting the industry's talking points that tout the inherent wonderfulness of privatized health care. This is a sad tribute to the death of critical thinking and the ascendancy of PR and advertising to take its place.

But despite the best efforts of our bought-and-paid-for political "leaders," who are delivering exactly the kind of government you'd expect in an insanely corrupt bribocracy, they can only keep the peasants down for so long. "Sicko" has unleashed decades of pent-up rage at the sheer inhumanity of the American health care model. It's hard to find anyone who isn't furious at the profits-over-patients ethos that drives that model and -- happy, happy, glorious day -- they're finally starting to organize. There will be hell to pay if politicians continue to ignore this issue, or offer half-baked faux solutions that seem on the surface to be improvements but, according to the fine print, only serve to protect and perpetuate the status quo.

Health care is either a right or a privilege. Ultimately, that’s going to be the central question regarding any effort at health care reform in this country. And when the dust finally settles, after another 18,000 or maybe 36,000 Americans die from lack of health care, it's increasingly likely that the industry parasites, the rabid free-marketeers, the privatization zealots and the paid apologists for this deadly system will be the ones left behind.


A version of this article first appeared in Online Journal July 6, 2007. Go here to read my follow-up on the Journal, or just scroll down an inch or so and read it here.

Universal health care, Islamic extremists and the gleaming scalpels of doom

“We must remove their appendixes over there so we don’t have to do it here.”

OK, I made up the quote above. Even President Malaprop hasn’t tried that one yet, although it’s likely being tested for credibility and traction on some focus group as we speak. But to the point…

A couple of weeks ago, I wrote an article for Online Journal called “Health care wars and the lies the for-profit racketeers tell us.” I wrote it to offer my best educated guesses on how the health insurance industry will attack Michael Moore’s “Sicko” and, even more critical to them, blunt the groundswell of public anger and outrage this movie has generated all across the country.

News reports and blog postings from Florida to Alaska suggest Moore is responsible for creating widespread public revulsion regarding our ongoing public health catastrophe. Apparently, it crosses standard demographic barriers, race and class distinctions. And it points an accusing finger directly at the tragicomic fiction that the for-profit health care industry’s sole concern is the welfare of its subscribers.


A little background
My column was written from the perspective of someone whose day job for the past 15 or so years has been consulting spinmeister to corporate America. Prior to that, I was a “senior media relations manager” with a division of a very large software company whose initials are not MS. In short, I’ve got a ton of experience at devising PR strategies and campaigns, some of which have included damage control or “crisis management” as their prime objective, and all of which are designed to deceive, manipulate opinion or destroy the counterweight of critical thinking – or all of the above. It’s soul-shriveling work, but it pays well.

I often atone for my professional sins by using my experience to help people understand how, for example, effective corporate spin-doctoring shifts the focus of cynicism and outrage away from the machinations of big business and attempts to direct it toward whoever or whatever is challenging their public image and benevolent-corporate-citizenship mythology.


Creating and focusing mass opinion
This process of shifting public focus from the crimes of the perps to sins of their accuser takes many forms, occasionally by attempting to rebut the challenger’s views, but more often simply by assassinating the challenger’s character. This has become standard practice in business and politics. You have only to look back to 2004 and the “swift-boating” of John Kerry to see it elevated to an art form. And now Moore is having his own swift-boating experience, trashed by the usual reactionaries as an anti-American, anti-free market, anti-capitalism fanatic who wants to destroy one of the US’ most dominant corporate institutions.

Having destroyed the challenger’s credibility, the tactics now shift to engaging the enemy in “reasoned” debate. In any PR campaign, sets of official talking points evolve to provide “balance, context and support” for the official story. In this case, about a half-dozen standard objections to single-payer specifically, and to universal access in general, pop up every time these issues are widely discussed – the last time being Clinton’s bloated, indecipherable “near universal coverage” plan, which still scared the industry into a $100 million ad campaign to convince Americans that they’d be nuts to tamper with the status quo.

So for last week’s article, I put together a set of talking points that I expect we’ll hear from the usual corporate shills in Congress and mass media. I also provided arguments and counter-spin points that easily debunk the conventional nonsense about the dark secrets and socialistic evils of universal health care.

And I thought I did a pretty good job overall. However, last Thursday, even as my article sat in Online Journal editor Bev Conover’s computer, scheduled for placement in Friday’s edition, the health care industry came up with something so ridiculous, yet so ingeniously creative, that I really should have seen it coming.


Fox News: The wingnut full-employment act
With Fox News’ customary humility and understatement, we learn that “Today on Fox News’s Your World With Neil Cavuto, National Review Online columnist Jerry Bowyer attacked Michael Moore’s movie SiCKO and its positive portrayal of the health care in countries such as Britain and France.”

OK, so what? Been there, done that. However, Bowyer unveiled a brand new industry weapon in the health care wars. Official wingnut doctrine says Americans must fear Muslim extremists. They must also fear universal health care. It’s pure genius to combine these two phobias and come up with this caliber of hogwash. From the Bowyer transcript (and people say he hadn’t been drinking):

“A state run health care enterprise is bureaucratic, and I think the terrorists have shown over and over again, whether it’s dealing with INS or whether it’s dealing with airport security, they’re very good at gaming the system with bureaucracies. They’re very good at getting around bureaucracies…

“And if one of your guys is a jihadist, if one of your doctors is spending all the time online reading Osama bin Laden fatwas, someone’s going to notice that (in the US). But the National Health Service is more like the post office, you know there’s a lot of anonymity, it’s easy to hide in the bureaucracy.”

As evidence, Bowyer cites the recent bombing attempts in the UK, which were allegedly perpetrated by seven National Health Service doctors, along with the wife of one of the docs who also works in the medical field. All eight are immigrants from either India or the Middle East, all eight came to the UK because the NHS suffers from a chronic shortage of qualified docs and nurses (thanks mainly to Maggie and Major underfunding it for 17 years in a Tory effort to get Brits to support US-style privatization) and all eight are Muslims.

So apparently Bowyer’s thesis is: Single-payer, universal access means millions of Americans who had previously lacked the insurance or the money to visit a doctor would suddenly flood waiting rooms, hospitals and clinics all across the country. The current supply of trained medical professionals in the US won’t be able to handle an additional 80 million patients (consensus rough estimate of the combined number of uninsured and underinsured in this country).

Docs and nurses would have to be imported from other countries, some of them inevitably Islamic, to cope with the onslaught of new patients. Some of those countries breed, harbor or covertly encourage Islamic jihad against the US. Therefore, medical professionals from those countries could also be fanatical anti-US Islamic terrorists using newly enacted single-payer legislation as leverage for fast-track immigration clearance. Once admitted to the country, they would simply disappear into the anonymity of a giant new health care bureaucracy, treating patients by day and blowing up the American infrastructure by night.

You can check Jerry out further at his web site. He’s actually a fairly interesting guy for a wingnut and, from reading through some of his articles, I get the feeling he’s not enough of an ideological purist to be the point man for this kind of garbage. Still, there he was on Fox…


The right wing echo chamber circles the wagons
You’d think that any self-respecting pundit would run away from such complete idiocy as if his pants were on fire. But that would be underestimating the lockstep cohesiveness that characterizes the right wing in America these days as it clings desperately to any argument, no matter how absurd, that advances its intellectually and morally bankrupt agenda.

So, in support of Bowyer’s fantasy -- which looks very much like a trial balloon floated by the industry’s PR machine to see how many imbeciles buy into it -- syndicated columnist, author, luxury cruiser with other National Review luminaries and more raving wingnuts than there are asteroids, star of the TV/radio interview circuit and tireless self-promoting right wing shill Mark Steyn weighs in with a July 8 piece on the horrors of imported docs, intensifying the endless 9/11 hangover that’s warped the thinking of millions of gullible Americans and feeds the free-floating fear, suspicion, angst and xenophobia that typifies it.

“Does government health care inevitably lead to homicidal doctors who can't wait to leap into a flaming SUV and drive it through the check-in counter? No. But government health care does lead to a dependence on medical staff imported from other countries.”

See… he’s a reasonable guy. He recognizes that not all Middle Eastern guys with swarthy complexions and medical degrees are fanatical anti-western bomb throwers. But that possibility remains, and if we institute single-payer here, we open ourselves up to the same kinds of terrorist threats now present in the UK. After all…

“Mohammed Asha, Mohammed Haneef and their comrades didn't even require a work permit to come and practice as doctors in state hospitals. You don't have to be the smartest jihadist in the cave to see that as an opportunity…”


Steyn’s position, translated into our native tongue
So, to extrapolate, Mark actually prefers having about 45 million uninsured and another 35 million or so underinsured so they can’t over-stress the current supply of docs and medical facilities and force Mark to wait a little longer to see his proctologist.

If those 80 million suddenly have access to quality medical care – which is to say, if they can finally get that weird lump looked at by a specialist, or have that painful scratched cornea treated, or get that CAT scan or blood test or MRI or tox screen or any of the other standard medical procedures that well-insured elitists like Mark take for granted while 80 million Americans go without – if that happens, they’ll quickly overwhelm existing medical resources and the US will have to look abroad to fill staffing requirements.

And because in Jerry’s and Mark’s delusional world a certain percentage of these overseas docs will prove to be Islamic terrorists, buildings will come tumbling down, bridges will collapse, pets will be poisoned (wait; somebody already did that), Jeeps will be set aflame and launched at airport ticket counters… They might even disrupt communications such that vast areas of the country would be prevented from seeing reruns of “American Idol.” Now that’s terrorism.


In his own words
Just so you understand where Mark’s coming from, here are a few jewels from his own web site.

On Iraq: In the summer of 2002, Amr Moussa, Secretary-General of the Arab League, warned BBC listeners that a US invasion would “threaten the whole stability of the Middle East”. I wrote: “He’s missing the point: that’s the reason it’s such a great idea.” Invading Iraq made sense because it offered the best way to prick the puffed-up pustule of regional stability.

On nationalism and xenophobia: … America is the western world’s odd man out, and has been increasingly since September 11th. Personally, I couldn’t be happier about it. I’m delighted the United States is “out of step” with, say, Belgium. Not because I’m Belgophobic. If the Belgians want to support the International Criminal Court, keep Saddam in office until his nuke arsenal is ready to fly, and continue subsidizing Yasser Arafat’s pay-offs to the relicts of suicide bombers, that’s fine, go ahead, you’re an independent nation.

On the liberal media: Six imams returning from a big conference of imams were removed from a plane at Minneapolis Airport after other passengers grew concerned about loud cries of “Allah akbar,” the imams reseating themselves in the same configuration as the 9/11 hijackers and demanding seat-belt extenders, even though none was of sufficient girth to need them. Aside from Fox, America’s national media showed little interest in the story. Nor, oddly, did the local media. …This is one of those stories that runs for a couple of days because he (a daily newspaper editor) chose to run it only for a couple of days. Had it been something more consequential – like, say, fictitious stories about guards at Gitmo desecrating the Koran – he would have run it into the ground.

And of course, Holy Joe likes Mark’s new book: “The thing I quote most from it is the power of demographics... But the other part is a kind of confirmation of what I know ... that Islamist extremism has an ideology, and it’s expansionist, it’s an aggressive ideology. And the title (“America Alone”) I took to mean that we Americans will have ultimate responsibility for stopping this expansionism.” Senator Joe Lieberman (Democrat [sic] of Connecticut)

So Mark’s a predictable purveyor of right wing doctrine, a counter balance to Agnew’s “nattering nabobs of negativism,” a staunch supporter of the US as antidote to the European world view, and a prominent member of the “fear, fear, terror, terror, all the time” paranoia-perpetuating chorus.

Personally, I wouldn’t trust such a warped personality to make correct change at McDonalds. Unfortunately, in today’s poisoned media ecosystem, he’s one of its more ubiquitous partisan hacks and influential fear-mongers.

Compared with the usual low standards of wingnut punditocracy, which lives by its ability to annihilate reason and logic, this one is unusually slick. Linking two of the right wing’s most terrifying phantoms into a single talking point is sheer PR genius, and I really should have seen it coming. That it’s inane, insane and incredible is beside the point. Just connecting these two harbingers of doom is sufficient.

I may need to take a few refresher classes, attend a thought manipulation seminar, read Chomsky’s “Manufacturing Consent” again. I’ve got to upgrade my skills lest I become another of those unemployable ghosts who spend their time on the Web sniveling about the good old days and trolling LinkedIn in case somebody’s actually looking for them.


An earlier version of this article appeared in Online Journal on July 13, 2007